Importance of epicardial adipose tissue localization using cardiac magnetic resonance imaging in patients with heart failure with mid‐range and preserved ejection fraction

Background Epicardial adipose tissue (EAT) has been implicated in the pathophysiology of heart failure (HF) with left ventricular ejection fraction (LVEF) >40%, but whether this is due to a regional or global effect of EAT remains unclear. Hypothesis Regional EAT is associated with alterations in local cardiac structure and function. Methods Patients with HF and LVEF >40% were studied. Cardiac Magnetic Resonance imaging was used to localize EAT surrounding the right ventricle (RV) and LV separately, using anterior‐ and posterior interventricular grooves as boundaries. Atrial‐ and ventricular EAT were differentiated using the mitral‐valve position. All EAT depots were related to the adjacent myocardial structure. Results 102 consecutive HF patients were enrolled. The majority of EAT was present around the RV (42% of total EAT, p < .001). RV‐EAT showed a strong association with increased RV mass ( β = 0.60, p < .001) and remained associated with RV mass after adjusting for total EAT, sex, N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP), renal function and blood glucose. LV‐EAT showed a similar association with LV mass in univariable analysis, albeit less pronounced ( β = 0.24, p = .02). Atrial EAT was increased in patients with atrial fibrillation compared to those without atrial fibrillation (30 vs. 26 ml/m 2 , p = .04), whereas ventricular EAT was similar (74 vs. 75 ml/m 2 , p = .9). Conclusions Regional EAT is strongly associated with local cardiac structure and function in HF patients with LVEF >40%. These data support the hypothesis that regional EAT is involved in the pathophysiology of HF with LVEF >40%.